Racially Minoritized Families’ Perspectives on Barriers and Facilitators to Pediatric Dermatology Care

Importance: Dermatology care is disproportionately limited for racially and ethnically minoritized patients. This study explores family perspectives to identify barriers and facilitators to pediatric dermatology care. Objective: To characterize the experiences of racially minoritized families in accessing pediatric dermatology at an academic children's hospital and understand how the hospital system and the medical team could better support these families. Design, Setting, and Participants: In this qualitative study, semistructured interviews were conducted from November 2, 2023, to January 23, 2024. Thematic analysis was performed using a reflexive, team-based inductive approach in a pediatric dermatology clinic at a large academic children's hospital in Colorado. Minoritized participants included parents and guardians of patients who identified as American Indian or Alaska Native, Black, or Hispanic in the electronic health record and spoke English or Spanish. Patients were allowed to identify as more than 1 race as long as 1 of their racial identities met the inclusion criteria. Data were analyzed between March 2024 and March 2025. Main Outcomes and Measures: Recorded interview responses with key themes related to barriers and facilitators to engaging with pediatric dermatology care. Results: In total, 32 parents were interviewed (28 women [87.50%]; mean [SD] age, 38.88 [10.1] years), among whom 12 (37.50%) identified as American Indian or Alaska Native, 11 (34.38%) as Black, 14 (43.75%) as Hispanic, and 4 (12.50%) as White; 6 participants had children who identified with more than 1 race. Themes were organized into barriers and facilitators. Themes that acted as barriers to receiving dermatology care included unfamiliarity with dermatology, difficulty navigating the health care system, overlooking skin health, low socioeconomic status, residing far from a hospital, parental non-English primary language, confusion over team-based care, poor clinician communication skills, lack of racial representation at hospitals, long appointment wait times, distrust of health care, assuming high expenses for care, and uncertainty of insurance coverage. Themes that were facilitators to care included parents strongly advocating for their children, familiarity with the hospital system, prior exposure to dermatology, children requesting dermatology care, clinicians with exceptional communication skills, referral from primary care clinicians, support from family and friends, presence of interpreters, normalization of dermatology by community and social media, and adequate insurance coverage. Parents viewed the interviews positively as a way to feel valued, express frustration, and critically reflect on their dermatology care experience. Conclusions and Relevance: This qualitative study identified addressable barriers and facilitators to pediatric dermatology care for racially minoritized families. The findings suggest that efforts within the health care system to broaden awareness of dermatology, improve system navigation, and increase representation may advance equitable care.